Deciding where to do away rotations

[hopemedbound]

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Simple question that has been bugging me for a while, what is the best way to decide which programs to do 4th year away rotations at for EM?
Should I do one in the area if the country I want to go in, and then another one at a well known institution?
And does anyone have any recommendations as far where to do an EM rotation do get a great experience/Letter of Rec.?

thanks
seth

 

[trkd]

Simple question that has been bugging me for a while, what is the best way to decide which programs to do 4th year away rotations at for EM?
Should I do one in the area if the country I want to go in, and then another one at a well known institution?
And does anyone have any recommendations as far where to do an EM rotation do get a great experience/Letter of Rec.?

thanks
seth

I vote for doing it in the area you want to go. It shows you have true interest in matching in the area AND they often know the letter writers at the programs close by. Furthermore, if you rotate somewhere that you want to match, they will get to meet you and like you. This is key because a known quantity is always better than an unknown (unless your personality sucks of course 😛 ). You will hear arguments for both though.

 

[EM_Rebuilder]

Also talk to your mentor or find someone on this board to go over your step scores, grades, etc etc and make sure you go to a place where you have at least a decent chance of matching.... If you are marginal at best, you probably should not do two away rotations at two of the most popular places as you chances of matching there may be slim, and you might throw out you chance of matching at a less competitive place. Before you ask 'what are the best schools' (as there is no agreement on this) but I think its best to think about the location of each place and decide if people generally want to live there. It seems like the competitiveness in EM programs are based more on where people would rather live than a program being 'top notch'....

Also agree on the omitting regional bias from you application by say living in Maine and doing an away in California... other CA programs are gonna look at you harder when they see that SLOR from the school across the street...


Good Luck

 

[my own reality]

I'm also trying to decide where to do away rotations. I live in the SE and am trying to stay somewhere in this area, was told that Vandy was a great place but unfortunately they're not accepting visiting students this year.

Heard conflicting stories about whether doing aways at Carolinas is a good idea or not, anyone have input on that?? Thanks guys...

 

[goblue1]

My 2 cents…
This time last year, I was considering doing an away rotation. I debated about it for a while and decided not to do one – I couldn’t have been happier with my decision. These are a few things to consider:
-If you have a decent EM program at your home program, you do not need to get outside LORs, etc. If your home program does not have a residency or what you feel like is a strong program, then you may want to consider rotating somewhere else.
-I was advised to do it if you have that 1 or 2 “dream” programs you were interested in; otherwise, it might not be helpful. For what it is worth, the program that I was strongly interested in doing an away in ended up being ranked pretty low on my list.
- I was asked at almost every interview if I had done EM rotations at other hospitals (not sure if this was a legal question). They may have been asking this question to gage experience, but I also got the feeling that they wanted to know how interested I really was in their program. For example, if I did an away rotation in Texas, am I truly that interested it Boston?
- This is a less important reason, but you also have to remember that you are adding 1 more stressful month into your fourth year (around the time of Step 2, applications, personal statements, etc.).
Saying all of this, I think there are some benefits to doing an away rotation – you get to check out the program, they get to check you out, pretty much a guaranteed interview, more experience, etc. Certainly, though, do not feel that you have to do one and strongly consider the pros/cons. Talk to your advisor about it.

Good luck!

 

[substanceP]

Heard conflicting stories about whether doing aways at Carolinas is a good idea or not, anyone have input on that?? Thanks guys...

a buddy from my med school class did a month at carolinas and wasn't even offered an interview there. another person from my class didn't do an away there and matched there. this leads me to believe that numbers are more important to them than some other places, but I could be wrong. neither person had any personality issues or red flags, but the one who matched there definitely had better numbers.

 

[Haemr Head]

First and foremost, go for the education.

Let's take Carolinas as an example. Even if you don't interview there or even want to match there, Carolinas has one of the best pathology mixes and teachers in the country. It's hard to imagine the rotation would not be superb.

Rotating at a program where you would like to match makes sense, particularly if you feel that your clinical skills are reasonable to strong for a 4th year student. It does help. Finally there are very competitive programs in most places in the country so the best answer is both.

Another reason is to go to a specific place is to meet recognizable names in the specialty for advice and letters. A letter from Marx at Carolinas, if you can get one, is very helpful even if you don't interview there. Working a shift with Marx may be one of the best experiences you'll ever have in training.

 

[Hawk22]

I just matched at Carolinas and rotated there last fall. It is definitely true that they don't offer everyone who rotates there an interview, which can be tough if you've busted your butt there for a month. I really enjoyed my rotation and have no doubt that working with the residents and attendings significantly improved my chances to match there.

In general, I think rotating helps you at most places if you do well. If you don't do well, then you've obviosuly shot yourself in the foot. It is a gamble, but one that is worth it most of the time in my opinion.

If you want to match in a specific program, then my advice is to rotate there. You'll get a better feel for things and get to know the residents and faculty in much better detail. Remember, an away rotation is as much about YOU deciding if you like the place as them deciding if they like you. However, you should also be realistic and know that some places are very competative even if you rotate there AND do very well.

If you want to match in a region (southeast, midwes, California, etc), then picking a program in the same region definitely helps. If you're not dead-set on a specific program, pick the best student rotation and location where you think you can get the best letter. I also think there is something to be said for rotating at a program that is a different type than your own home program, for example going to a county program if you're from a very academic place, etc.

Off the top of my head, I've heard great things about the student rotations at Indy, Vandy, and Emory. I also rotated at UNC and Carolinas, which I thought were excellent months as well. I'm sure others can chime in and give other examples of great student rotations at other programs and in other areas of the country.

 

[trkd]

I just matched at Carolinas and rotated there last fall. It is definitely true that they don't offer everyone who rotates there an interview, which can be tough if you've busted your butt there for a month. I really enjoyed my rotation and have no doubt that working with the residents and attednings significantly improved my chances to match there.

In general, I think rotating helps you at most places if you do well. If you don't do well, then you've obviosuly shot yourself in the foot. It is a gamble, but one that is worth it most of the time in my opinion.

If you want to match in a specific program, then my advice is to rotate there. You'll get a better feel for things and get to know the residents and faculty in much better detail. Remember, an away rotation is as much about YOU deciding if you like the place as them deciding if they like you. However, you should also be realistic and know that some places are very competative even if you rotate there AND do very well.

If you want to match in a region (southeast, midwes, California, etc), then picking a program in the same region definitely helps. If you're not dead-set on a specific program, pick the best student rotation and location where you think you can get the best letter. I also think there is something to be said for rotating at a program that is a different type than your own home program, for example going to a county program if you're from a very academic place, etc.

Off the top of my head, I've heard great things about the student rotations at Indy, Vandy, and Emory. I also rotated at UNC and Carolinas, which I thought were excellent months as well. I'm sure others can chime in and give other examples of great student rotations at other programs and in other areas of the country.

I rotated at UNC as well and thought it was great. My friend did EM at Emory and they set you up with a particular attending to work at least 4 (or something like that) shifts so that you are able to get a LOR. I thought that was a great idea! I ALSO agree that doing a rotation is as much about you as it is them. I rotated at a program that I thought would end up as my number 1. After rotating, I didn't like that area and a few other things about the set up and ended up cancelling my interview there. I would have never seen these things on just the interview day. If you have a program in mind, then rotate there (unless you here the rotation but not the residency itself is awful for some reason I guess). OR at least rotate close and check out the program from close by (if the program across the street has an awesome set up for students or something). I think most places give you an interview after you rotate so I wouldn't worry too much about that.

 

[Cal2Lane]

I did two aways at California programs (and wanted to stay at California). While it didn't prevent me from getting interviews across the country, more than once various interviewers asked me about where I really wanted to be since it wasn't really a secret. That being said, it worked out great for me and I matched at a program I rotated out, but you should be careful in painting yourself into a geographic corner. If you do all your aways in sunny Florida, maybe programs will be less likely to think that you will move to Providence, etc. Good luck.

 

[Pinner Doc]

Here's my question--

I would like to do an away rotation at a site to which I'm applying (OHSU, Stanford, etc... by the way, Denver is already booked for Sept!). The trouble is, these programs are all on 4-week schedules, while my school rotates by calendar month. I'm told by my dean that there's a good chance that the director of my sub-I at home in August won't be thrilled (and may not OK it) if I cut out of my sub-I early to go do an away elective at these 4-week programs that start on August 27.

The University of Vermont has an away EM rotation that goes by calendar month, like my school. My boyfriend lives in Burlington, so I'd have a free place to stay. It's exactly the type of community in which I'd love to live eventually. The trouble is, it doesn't have an EM residency program. Would it be weird to do an elective there, given that fact? I'd probably be able to get a letter out of it, but will programs wonder why I bothered rotating there?

 

[membsr-8890]

There's already been great advice on where to rotate based on your interest in the particular program or area of the country.

One more piece of advice:
Try to rotate at a place completely different from your home program. If, for example, your home program is a strong county facility, do an away at a solid community/adademic program. This will help you a LOT down the road. When you're applying to residency programs you can narrow the list down with a much more solid base knowledge of at least the type of program where you'd like to end up.

 

[trkd]

Here's my question--

I would like to do an away rotation at a site to which I'm applying (OHSU, Stanford, etc... by the way, Denver is already booked for Sept!). The trouble is, these programs are all on 4-week schedules, while my school rotates by calendar month. I'm told by my dean that there's a good chance that the director of my sub-I at home in August won't be thrilled (and may not OK it) if I cut out of my sub-I early to go do an away elective at these 4-week programs that start on August 27.

The University of Vermont has an away EM rotation that goes by calendar month, like my school. My boyfriend lives in Burlington, so I'd have a free place to stay. It's exactly the type of community in which I'd love to live eventually. The trouble is, it doesn't have an EM residency program. Would it be weird to do an elective there, given that fact? I'd probably be able to get a letter out of it, but will programs wonder why I bothered rotating there?

Sorry to tell you but not such a grand idea for getting a letter. It may suck but doing one at a place with a residency means much more as far as LORs go. This makes sense because a place that has EM residents knows what makes a good EM resident. Furthermore, I think only em docs at places with residencies are supposed to write SLORs. Otherwise, some of the questions like "how likely are you to rank this person highly" don't really apply. Try somewhere else close. As far as you supervisor not letting you out of a rotation a few days early, that person sucks BIG TIME! I would ask anyway. Surely it is not the first time it has been suggested based on the fact that it is an atypical schedule to most schools.

 

[deleted109597]

Or, alternatively, don't clear it through the supervisor. Clear it from the person who writes your grade (ie, your attending, chief resident, fellow).

Also, you might still be able to do another 4 week place, because you don't work every day of the week in EM, so you can miss a few days at the beginning/end and not miss much (unless they have a huge orientation, which most don't).

 

[joeG]

Simple question that has been bugging me for a while, what is the best way to decide which programs to do 4th year away rotations at for EM?
Should I do one in the area if the country I want to go in, and then another one at a well known institution?
And does anyone have any recommendations as far where to do an EM rotation do get a great experience/Letter of Rec.?

I recommend definitely doing your rotation in the region where you want to do residency. It does not have to be at the program you want to attend - but if it is not, you better do enough research about the program to know that you'll be happy there.

As a med student, it isn't always easy getting a good recommendation during the EM rotation because you may spend limited time with the same attending during your shifts. One program that pairs you up with an attending (for better or for worse) is St Lukes/Roosevelt in NYC. If you are a hard worker - the attending that you just spent 12 shifts with will certainly notice you and likely write an excellent letter. Whereas other programs, you end up asking the attending that you got along best with for a letter.

Also, I would only do a total of 2 EM rotations. One at your home institution and the other in the geographic location you want to train.

 

[trkd]

Or, alternatively, don't clear it through the supervisor. Clear it from the person who writes your grade (ie, your attending, chief resident, fellow).

Also, you might still be able to do another 4 week place, because you don't work every day of the week in EM, so you can miss a few days at the beginning/end and not miss much (unless they have a huge orientation, which most don't).

Hey, that's a great idea McNinja. Yeah, just tell them you can't show up until the first. It will be no problem because in most places you only do 14 shifts in 4 weeks. Doesn't hurt to ask. 👍

 

[Pinner Doc]

Thanks to all for the input. I'll definitely see if I can work around the scheduling difficulties. Very good suggestion!

Along the same vein, UW has an EM elective but no associated residency training program. Are they affiliated with the Tacoma program? Or would I just be digging myself into the same hole?

 

[Dr. Will]

Again...you want a residency program wherever you rotate. Besides...Seattle doesn't have any EM programs unless you are in the Army.

 

[ElZorro]

agree with above, rotate at places that are different from your home site. I rotated at 2 academic institutions as well as one mega county program. I realized within 2 weeks that county was definantly not for me. Really helped me refine my interview list and save a bunch of money that would have been wasted interviewing at county joints. Who knows, if I hadn't rotated there I might not have realized I didn't like that environment till it was too late and I matched there....so for sure try to evaluate what type of program you like. Also, you may consider doing a rotation at a smaller "off the map" program first just to maybe get a little more personal attention and mentorship, unless you feel your home program can provide this.

 

[Haemr Head]

Unless things have changed, UW remains one of the last bastions of resistance to our specialty. A letter from Harborview saying that you would make a great EM specialist, would probably be viewed by many reviewers as meaningless or even a negative. Until they have board certified, EM trained leadership in place and an ACGME accredited training program, I would not set foot in the door.

 

[JBlue]

I am kind of confused about who to get your letters from. I am hopefully doing an away at Emory in the fall and someone mentioned here that they match you with an EP so that you can get a letter. However, I thought you really needed a letter from the PD where you rotate. So, in that case would I get two letters, one from the EP and then approach the PD for a letter as well?

 

[Hawk22]

I am kind of confused about who to get your letters from. I am hopefully doing an away at Emory in the fall and someone mentioned here that they match you with an EP so that you can get a letter. However, I thought you really needed a letter from the PD where you rotate. So, in that case would I get two letters, one from the EP and then approach the PD for a letter as well?

It depends on the program and where you rotate, as different places have different policies.

Many programs do a composite letter that combines comments from everyone who worked with you during the rotation, which often comes with the official signiture of the PD or higher faculty member. Some places instead have a clerkship coordinator, who is a faculty member responsible for writing a similar official SLOR for all the students who rotate there. Most of these folks are very well known and write letters every year, so a letter from them is excellent as well.

You can also get any faculty who works with you to write an individual letter, but be sure they do a SLOR as these are generally looked upon as a more favorable format (some letter writers prefer to write a traditional letter or rec and combine it with a SLOR, which works well too).

A letter from a PD is very nice and can definitely help you if it reflects well on you as an applicant, but this isn't an absolutely essential thing for a successful application.

 

[deleted77919]

A letter from a PD is very nice and can definitely help you if it reflects well on you as an applicant, but this isn't an absolutely essential thing for a successful application.

A letter from a PD probably isn't worth very much if they haven't actually spent a lot of time with you. I was listening to a PD from an NYC program speak and he gave an example where he received a letter from a college (another PD) he knew very well. The letter started out something like "Applicant X appeared very motivated and interested in EM during the one shift I worked with him." He said he stopped reading the letter right there, totally worthless.

 

[Hawk22]

^ This is definitely true, unless it is a composite letter from the department that covers your whole rotation.

That's also pretty good advice for anyone writing you a letter, not just a PD. Letters from people who know you well are always better.

 

[trkd]

I am kind of confused about who to get your letters from. I am hopefully doing an away at Emory in the fall and someone mentioned here that they match you with an EP so that you can get a letter. However, I thought you really needed a letter from the PD where you rotate. So, in that case would I get two letters, one from the EP and then approach the PD for a letter as well?

Yeah, that was me. As stated above, someone who knows you well is better than a PD that doesn't. I only had one PD letter and that was after only working 1 shift. However, it was a composite letter written by him after emailing out a "so what do you guys think about trkd" email. I would be surprised if most people have all PD letters but I guess I could be wrong. Also keep in mind that asst PDs are just about as good so don't forget about getting a letter from them if that is easier.

 

[JBlue]

I am only planning on doing one away (I am expecting in late Aug. and can only swing one before the baby comes) and my home institution does not have a residency program. I know I will get a good letter from the Chief of EM at our hospital but Emory is going to be my only letter from an actual residency program. Does this make it more important that I get a letter from the PD or assistant PD? Should I try to get 2 letters from this away or is one sufficient even though I will only have 1 other SLOR (from our Chief)?

 

[Dr. Will]

I am only planning on doing one away (I am expecting in late Aug. and can only swing one before the baby comes) and my home institution does not have a residency program. I know I will get a good letter from the Chief of EM at our hospital but Emory is going to be my only letter from an actual residency program. Does this make it more important that I get a letter from the PD or assistant PD? Should I try to get 2 letters from this away or is one sufficient even though I will only have 1 other SLOR (from our Chief)?

Get a letter from someone who has worked more than one shift with you. This comes up year after year. A letter from someone who knows you and is detailed is much better than one from someone who barely knows you and is very general. If you are able to schedule multiple shifts with the PD or Associate PD, then more power to you. Otherwise, approach the person who you had the most interaction with.

 

[trkd]

Get a letter from someone who has worked more than one shift with you. This comes up year after year. A letter from someone who knows you and is detailed is much better than one from someone who barely knows you and is very general. If you are able to schedule multiple shifts with the PD or Associate PD, then more power to you. Otherwise, approach the person who you had the most interaction with.

I second this. Also, there is nothing stopping you from getting more than one letter per program. Schedule or switch around your schedule so that you can get to work with your scheduled person and also another person for at least 2-3 shifts. If you explain the baby situation to the program coodinator the baby situation and that you NEED 2 letters from this rotation, you may get some sympathy and extra shift reworking. This will get you 2 letters. Also, make sure you ask the emory program coordinator whether they are still doing this thing where they set you up with a doc to work with a few times. My friend rotated there last year and was set up with a person but you should check to make sure this will be done for you since this is a letter you are really counting on.

 

[roja]

A letter from a PD probably isn't worth very much if they haven't actually spent a lot of time with you. I was listening to a PD from an NYC program speak and he gave an example where he received a letter from a college (another PD) he knew very well. The letter started out something like "Applicant X appeared very motivated and interested in EM during the one shift I worked with him." He said he stopped reading the letter right there, totally worthless.

Not to mention they all know each other. EM is a pretty small world, but EM in NYC is like a tightly knit little family. Everyone knows everyone. Rotate at one program in NYC and you in essence have a LOR that spans all of NYC.